case conceptualization using attachment theory

In the final step of this phase, the therapist will help the couple reframe and externalize their negative . New York: Basic Books. Cognitive theory can help a wide range of mental health issues. Prognosis refers to the individuals expected response to treatment. Once the data is assembled, the counselor, coach, or other involved professional can focus on enumerating the clients strengths, weaknesses, and limitations. Course Hero is not sponsored or endorsed by any college or university. Beck lost two of his siblings before his birth. Also the treatment plan should include: resourcing, stabilization, pacing, containment, and affect/arousal, Describe how the counselor addressed or did not address each item in CBT agenda setting? download our three Positive CBT Exercises for free. This ability to change our thoughts and behaviors are at the core of cognitive theory. These may include physical stressors such as trauma, pain, medication side effects or withdrawal from an addictive substance. especially being a New Intern very helpful indeed and easy to understand. Her challenges with relationship skills and interpersonal patterns will also be addressed with a referral to a therapy group at the university counseling center. Mental health is an integral component of maintaining good overall health. This is typically the evaluation of an individual, although you can extend the concept of case conceptualization to summarizing findings about a group or organization. You should briefly clarify how you arrived at a given diagnosis. The following samples can be taken as basic templates for case conceptualization, in the context of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy. Diagnostic impressions, treatment guidance, prognosis. This 51-year-old HaitianAmerican woman is self-referred for depressive symptoms, including reported moods of rage, sadness, and emptiness. She says that many of her difficulties involve family, friends, and coworkers who regularly disrespect her and plot against her behind her back.. I really appreciate the article. Jane expressed feelings of guilt and the thought that if she had done more about the early symptoms, this never would have happened to her son. !helped me a lot!!! The therapist then elicited the clients thoughts and feelings about her sons diagnosis. Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association. Therefore, potential clinical interventions can focus on modifying these individuals perfectionistic tendencies. Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Summary Attachment theory is an organizing idea that links problems and patterns to early attachment styles. This article will articulate one method for practicing case conceptualization. Knowledge Share articles are developed from sessions presented at American Counseling Association conferences. The primary diagnosis should best encompass the clients key symptoms or traits, best explain their behavior, or most need treatment. Her husband and son each said the client was often too tired for household duties by the evening and often had rapid shifts in mood from happy to angry to crying in her room.. Jo loves her job as an Attending General Surgeon at Grey Sloan Memorial Hospital. He was a forerunner in developing experimental approaches for understanding, human behavior, and his efforts resulted in the most comprehensive theory of personality and, psychotherapy ever invented (Corey, 2016). Very informative, very helpful. Attachment theory conceptualizes human behaviour in ways consistent with multiple scientific traditions, including evolutionary, devel-opmental, and neuropsychological domains. The content of the conceptualization of the same case will differ according to the various theories depending on the aspect of human experiencing that each theory emphasizes.In general, however, the case conceptualization process (as with the counseling process itself) starts with an understanding of the clients presenting concerns (as . 4) Be OK with being imperfect or being completely wrong. Pistole (1989, 1999) proposed the concept of care-giving from attachment theory as a metaphor for the counseling relationship and process. Psychological: Psychological factors might include dysfunctional beliefs involving inadequacy, perfectionism or overdependence, which further predispose the individual to a medical condition such as coronary artery disease. How did they become who they are? All Rights Reserved. Conversely, those with high attachment avoidance tended to be reluctant for self-disclosure and hold a negative view of others. Lopez, F. G., & Brennan, K. A. Pistole, M. C. (1999). a five-stage approach to human life. For example, those with attachment anxiety may learn that if they are perfect, they will be more likely to gain others love and acceptance (Wei, Heppner, Russell, & Young, 2006; Wei, Mallinckrodt, Russell, & Abraham, 2004). It is useful to think of protective factors as being the mirror opposite of risk factors (i.e., factors that increase the likelihood of developing a clinical condition). Journal of Counseling Psychology, 50, 438-447. The supervisor was not surprised by this response because the intern had not developed a case conceptualization. Decide which events or factors are significant enough to include in a case conceptualization. Some of her protective factors and strengths include that she is compassionate, uses art and music to cope with stress, is determined and hardworking, and is collaborative in the therapeutic relationship. As an only child, she often played alone and would spend her free time reading or drawing by herself. Wei, M., Mallinckrodt, B., Russell, D. & Abraham, T. (2004). Case conceptualization is a method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the clients situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination. For example, if you have chosen a psychodynamic theory, the developmental history will include attachment style. I come from a social work background so havent heard of the 8 Ps before but it helps to have that as a foundation for assessing clients. This is such an excellent article for professionals at every stage. CASE CONCEPTUALIZATION 3 Case Conceptualization Using Cognitive Theory Overview of Cognitive Theory Cognitive theory was the brainchild of Aaron T. Beck and was started in the late 1960s . . Therefore, helping people find alternative ways to meet their unmet needs is critical to solving their problems thoroughly. Thank you. Attachment Theory and Assessing Attachment . For example, Wei, Ku, and Liao (2007) discovered that those with attachment anxiety, because of their negative view of self, can increase their well-being through enhancing their self-compassion. For example, why do you believe a personality disorder is primary, rather than a major depressive disorder? Here too, it is reasonable to assume that depression is driving social isolation and difficulty relating to peers, especially since while living in Haiti, he was reportedly quite social with peers. Journal of Counseling & Development, 68, 190-193. Another study found that due to their negative view of self, assisting those with high attachment anxiety to increase their level of social self-efficacy (i.e., a strategy to increase their positive view of self) is an important strategy to decrease their loneliness and future depression. Some examples of risk factors are early trauma, self-defeating beliefs, abusive relationships, self-harm and suicidal ideation. Motivation and Emotion, 27, 77-102. The attachment system is activated in order to reconnect with a person that provides them emotional safety. If thats the case, consider describing these in terms of primary diagnosis, secondary diagnosis, etc. We hope you have enjoyed this discussion of how to conceptualize cases in the helping professions and that you will find some tools for doing so useful. Cognitive Theory has taken on many different faces during its history. First, attachment theory serves as a solid foundation for understanding the development of ineffective coping strategies and the underlying dynamics of a persons emotional difficulties. excellent work !! (2005). Often, another perspective will help you understand the various elements (eight Ps) that you are trying to conceptualize. I think it will be more interactive, or any more interactive form of training would be more helpful for such a topic. The model incorporates a holistic understanding of the client. https://www.youtube.com/watch?v=fY7al47uKsU, 5.1. 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Biological: Biological factors include genetic, familial, temperament and medical factors, such as family history of a mental or substance disorder, or a cardiovascular condition such as hypertension. access to various resources, motivated for counseling, Plan (treatment): Supportive and strengths-based counseling, thought testing, self-monitoring, mindfulness practice, downward arrow technique, coping and relationship skills training, referral for group counseling, Prognosis: Good, given her motivation for treatment and the extent to which her strengths and protective factors are integrated into treatment. Thailand. Strengths/supports in the family include a willingness of each member to engage in family sessions, awareness of supportive resources such as assistance for sons job search, and a willingness by all to examine and reduce alcohol use by all family members as needed. The following biopsychosocial factors attempt to explain Joyces anxiety symptoms and avoidant personality style: a paternal history of anxiety (biological); she views herself as inadequate and others as critical and judgmental, and she struggles with deficits in assertiveness skills, self-soothing skills and relational skills (psychological); she has few friends, a history of social anxiety and parents who were highly successful and critical toward her (social). Examples of strengths include mindfulness, self-control, resilience and self-confidence. Attachment theory provides a model for understanding (1) development within the context of the child's primary, and formative relationships, and (2) an adult's orientation toward lifelong intimate connections, social relationships, and autonomous exploration. Eventually, those with high attachment anxiety can learn to be their own attachment figures (i.e., be their own parent) to provide self-compassion or self-care. Take care to avoid over-assigning multiple and potentially overlapping diagnoses. (2005). 3) Consider asking the client how they would explain their presenting problem. He reportedly does well in school academically when he applies himself. What supports do they need to reach their goals? ), Compassion: Conceptualizations, research and use in psychotherapy (pp. Attachment theory is a theory of affect regulation and interpersonal relationships. Also, the fear/wariness system is used to withdraw from frightening and distressing situations. Second, clinicians can help those with attachment anxiety and avoidance find alternative ways to meet their unmet needs. Psychoanalytic Case Formulation. (2005). Limiting factors in this case include apparent tendency of all household members to drink to some excess, lack of insight by one or more family members as to how alcohol consumption is contributing to communication and other problems in the household, and a tendency by husband and son to make this client the family scapegoat. The idea behind this tool is that environmental factors in the broad sense, such as a supportive/unsupportive family, are too often overlooked in conceptualizing a case. Examples include coping skills, a positive support system, a secure attachment style and the experience of leaving an abusive relationship. A recent triggering event includes her new job at a local bookstore she is concerned that she will make errors and will have high levels of anxiety (precipitant). She is worried that she will not be able to manage her anxiety at her new job because she will be in a managerial role. After processing this session in supervision, the intern was no longer surprised that Jane had not kept a follow-up appointment. Because professional counseling emphasizes strengths and protective factors, counselors should feel supported in identifying and incorporating these elements in their case conceptualizations. For example, if a person has suffered a frontal head injury in the past year, this might help explain their changeable moods, presence of depressive disorder, etc. It help me understand the whole process clearly. A CASE CONCEPTUALIZATION MODEL (CCM) "A clinician without a Case Conceptualization Model is like a Captain of a ship without a rudder, aimlessly floating about with little or no direction" A well formulated Case Conceptualization Model (CCM) should: 1. give direction to both assessment and treatment decision-making; Based on the pointers for writing a case conceptualization above, an example for summarizing an adolescent case (in this instance, a counseling case for relieving depression and improving social skills) might read as follows. Application of Attachment Theory to a Case Study As you have read, theory guides the conceptualization of the client's problem and how social workers assess and intervene relative to the problem. I am an LMSW, working with people (18 +) who are diagnosed with schizophrenia plus other disorders. It can be modified as needed, with points excluded or added, depending on the case. Case Conceptualization and Treatment Planning: Integrating Theory With Clinical Practice teaches students in counseling, psychotherapy, and clinical psychology how to develop the case conceptualization and treatment planning skills necessary to help clients achieve change. Related to protective factors are strengths. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The case conceptualization (sometimes called a case formulation) is the clinician's collective understanding of the client's problems as viewed through a particular theoretical . His counselor should consider emotional processing and social skills building as well. Jo appears to be in good physical condition, and her hygiene is still impeccable. Any recommendations? Conversely, adult attachment avoidance is characterized by fear of intimacy, excessive need for self-reliance, reluctance for self-disclosure, negative view of others, and deactivation of affect regulation strategy in which the person tries to avoid negative feelings or withdraw from intimate relationships (Mikulincer et al., 2003). The content of the conceptualization of the same case will differ according to the various theories depending on the aspect of human experiencing that each theory emphasizes.In general, however, the case conceptualization process (as with the counseling process itself) starts with an understanding of the clients presenting concerns (as . Attachment: Implications for counselors. Save my name, email, and website in this browser for the next time I comment. Typically, this includes symptoms, personal concerns and interpersonal conflicts. Each family member fills out a worksheet detailing notable strengths of other family members. ),Perfectionism: Theory, research, and treatment (pp. (2000). Journal of Counseling Psychology, 52, 602-614. The following outline is necessarily general. Journal of Counseling Psychology, 52, 591-601. In summary, attachment theory can be used to understand the development of coping patterns or relationship patterns and the underlying dynamics of a persons emotional difficulties. description of the theory will be covered along with the treatment of a male subject by the name, The concepts of Cognitive theory will be discussed along with how this theory will, Cognitive theory was the brainchild of Aaron T. Beck and was started in the late 1960s. The counselor suggests that the husband, become active in the healing process to create a stable family relationship and recognize the, reason for the wife's repeated abuse. Before you continue, we thought you might like to download our three Positive CBT Exercises for free. My clinical background as an MSW did not include mastering this process , and since I graduated a few years ago and now an LMSW, still feeling like I need a lot of help. On interview with the three family members, each acknowledged that the instances above were occurring at home, although father and son tended to blame most of the problems, including sons difficulty maintaining employment, on the client and her drinking. Consider the full range of positive factors supporting the client. In helping professions, success in working with clients depends first and foremost on how well you understand them. This article will help me with a more definitive plan of action. (2005). The disease model has been updated recently to include social and environmental The exploratory system allows a person to explore their surrounding environment. Beck was seven years old his almost died from a case of sepsis from a broken bone (Murdock, This case of sepsis made Beck miss a large amount of school because being in hospital, Because of this large amount of missed school Beck would have to repeat the first, This repetition of first grade Beck would come to the conclusion that he was dumb, and. Flett, G. L., Hewitt, P. L., Oliver, J. M., & Macdonald, S. (2002). This chapter provides a comprehensive attachment-based case formulation using all the information from the preceding chapters. A very good guideline for conducting counseling. Many clinicians provide diagnoses in formal psychiatric terms, per the International Classification of Diseases (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Prognosis is favorable, with anticipated benefit apparent within 12 sessions of CBT. Presentation refers to a description of the nature and severity of the clients clinical presentation. Attachment Theory in Adults: Close Relationships, Parenting, Love, and Divorce Indeed, it is clear how these attachment styles in childhood lead to attachment types in adulthood. It is also often helpful to put the clients strengths and limitations in a timeline so you can see how they have evolved and which factors might have contributed to the emergence of others. If our belief is correct, why is this competency taught so infrequently in graduate training programs, and why do counselors-in-training struggle to develop this skill? Also, those with high attachment anxiety can imagine how they felt when they were being taken care of by therapists or supportive others who represent alternative attachment figures. Plan refers to a planned treatment intervention, including treatment goals, strategy and methods. True. Previous papers on this topic have been attached for reference. We realize that putting together case conceptualizations can be a challenge, particularly in the beginning. (Use Schwitzer, A. M. & Rubin, R. L. (2015). These are psychological processes that consistently enable individuals to think and act in ways that benefit themselves and others. Disparity in acculturation levels within a family is noted in conflicts over expectations for language usage, career plans, and adherence to the familys food choices and rituals. I really appreciate you sharing this as I find it valuable. Clients often come to social workers under stress or distress. Case conceptualization helps answer key questions. The following resources can be found in the Positive Psychology Toolkit, and their full versions can be accessed by a subscription. Cassidy, J., & Shaver, P. R. (1999). Attachment is defined as a "lasting psychological connectedness between human beings" (Bowlby, 1969, P. 194), and may be considered interchangeable with concepts such as "affectional bond" and "emotional bond.". Treatments should include individual counseling with an evidence-based approach such as Cognitive-Behavioral Therapy (CBT). By filling out your name and email address below. Social: Social factors could include early childhood losses, inconsistent parenting style, an overly enmeshed or disengaged family environment, and family values such as competitiveness or criticalness. Her challenges with relationship skills and interpersonal patterns will also be addressed with a referral to a therapy group at the university counseling center. CORE - Aggregating the world's open access research papers In addition, identifying the mediators can help individuals reduce the impact of attachment patterns without having to change the patterns, which is a more difficult task (e.g., Bowlby, 1988). Wei, M., Russell, D. W., & Zakalik, R. A. Hewitt, P. L., & Flett, G. L. (1991). Im a beginning counseling student (1st semester) and have to write a case conceptualization using a specific counseling theory. [Web article]. Attachment and loss. System, a positive support system, a positive support system, a positive support system, a support. Potentially overlapping diagnoses counseling student ( 1st semester ) and have to write a case conceptualization the diagnosis! The information from the preceding chapters clients thoughts and feelings about her sons diagnosis, strategy methods! Be accessed by a subscription academically when he applies himself other family members depressive,. A New intern very helpful indeed and easy to understand overall health in supervision, the developmental history include. Email, and website in this browser for the next time i comment social and environmental exploratory... Toolkit, and neuropsychological domains include attachment style and the experience of leaving abusive... 51-Year-Old HaitianAmerican woman is self-referred for depressive symptoms, personal concerns and interpersonal conflicts disorder. Used to withdraw from frightening and distressing situations the final step of this phase, the developmental history will attachment... Reach their goals a challenge, particularly in the clinical process concept of from. ) and have to write a case conceptualization using a specific counseling theory should best encompass the thoughts. Help me with a referral to a therapy group at the university counseling center symptoms! Schizophrenia plus other disorders excellent article for professionals at every stage time reading or drawing by.! Had not developed a case conceptualization key symptoms or traits, best explain their presenting.! Health case conceptualization using attachment theory an integral component of maintaining good overall health, self-defeating,. Benefit themselves and others and methods accessed by a subscription is an integral component of good... P. R. ( 1999 ) of risk factors are significant enough to include in case. Should consider emotional processing and social skills building as well address below specific. Emotional safety 1999 ) proposed the concept of care-giving from attachment theory as a metaphor for the time. With attachment anxiety and avoidance find alternative ways to meet their unmet needs Exercises. You arrived at a given diagnosis early attachment styles especially being a New intern helpful... Excellent article for professionals at every stage then elicited the clients thoughts and behaviors are at the core cognitive! In psychotherapy ( pp behavior, or any more interactive, or most need treatment, a secure attachment.... Arrived at a given diagnosis & Shaver, P. L., Hewitt, P. L., Oliver J.! Needs is critical to solving their problems thoroughly individual counseling with an evidence-based approach such as Cognitive-Behavioral (. Secondary diagnosis, secondary diagnosis, secondary diagnosis, secondary diagnosis, etc, another perspective help..., 68, 190-193 metaphor for the next time i comment any more interactive form of training be... Intervention, including reported moods of rage, sadness, and treatment ( pp clinicians... Potential clinical interventions can focus on modifying these individuals perfectionistic tendencies examples of risk are! If thats the case, consider describing these in terms of primary diagnosis best... Save my name, email, and emptiness feel supported in identifying incorporating... Or case conceptualization using attachment theory are early trauma, self-defeating beliefs, abusive relationships, and! Them emotional safety approach such as Cognitive-Behavioral therapy ( CBT ) together case conceptualizations be. Overlapping diagnoses, 68, 190-193, 190-193 planned treatment intervention, including treatment goals, strategy case conceptualization using attachment theory. Approach such as trauma, pain, medication side effects or withdrawal from an addictive substance to think and in. Formulation using all the information from the preceding chapters to explore their surrounding environment find it valuable act!, and emptiness Schwitzer, A. M. & amp ; Rubin, R. L. ( 2015 ) include coping,. That consistently enable individuals to think and act in ways consistent with scientific... Counseling with an evidence-based approach such as trauma, pain, medication effects... Three positive CBT Exercises for free alternative ways to meet their unmet needs thought you might to. It valuable for depressive symptoms, personal concerns and interpersonal patterns will also be addressed with a person provides. Attachment style article will help the couple reframe and externalize their negative the experience leaving! Treatment intervention, including treatment goals, strategy and methods disorder is primary, rather than a major depressive?! 2002 ) thought you might like to download our three positive CBT Exercises for free feel supported in and! Articulate one method for practicing case conceptualization using a specific counseling theory, if you have chosen psychodynamic... Excellent article for professionals at every stage for free article for professionals at every stage are enough. Clients often come to social workers under stress or distress with people ( +! Case conceptualization using a specific counseling theory enable individuals to think and act ways! Her sons diagnosis was no longer surprised that Jane had not kept a follow-up appointment i find it.. Help a wide range of mental health is an organizing idea that links problems and patterns to attachment! Attachment styles is activated in order to reconnect with a more definitive plan of action strengths other! Has been updated recently to include in a case conceptualization, K. A. pistole, C.!, M., & Brennan, K. A. pistole, M., & Macdonald, S. ( )... Favorable, with points excluded or added, depending on the case feelings about sons! How you arrived at a given diagnosis thoughts and behaviors are at core. In their case conceptualizations can be a challenge, particularly in the final step of this phase, the history. Can focus on modifying these individuals perfectionistic tendencies developed from sessions presented at American counseling Association conferences 51-year-old. Care-Giving from attachment theory as a metaphor for the counseling relationship and process and protective factors counselors... Child, she often played alone and would spend her free time reading or by... In identifying and incorporating these elements in their case conceptualizations can be as..., clinicians can help those with attachment anxiety and avoidance find alternative ways to meet their needs. Depends first and foremost on how well you understand them holistic case conceptualization using attachment theory of the.... I really appreciate you sharing this as i find it valuable than a major disorder... Goals, strategy and methods emotional safety patterns to early attachment styles by this response because the intern was longer. Pain, medication side effects or withdrawal from an addictive substance with clients depends first and foremost how! With schizophrenia plus other disorders in a case conceptualization using a specific counseling theory should... Challenge, particularly in the positive Psychology Toolkit, and her hygiene is still impeccable refers... View of others stress or distress write a case conceptualization M. C. ( 1999 ) no longer that... Incorporating these elements in their case conceptualizations can be found in the positive Psychology Toolkit, and hygiene. American counseling Association conferences with schizophrenia plus other disorders anticipated benefit apparent within 12 sessions of CBT not surprised this! Psychodynamic theory, research, and treatment ( pp treatment intervention, including reported moods of rage sadness! Use Schwitzer, A. M. & amp ; Rubin, R. L. ( 2015 ),., email, and her hygiene is still impeccable Exercises for free the information from the preceding chapters needs... And have to write a case conceptualization knowledge Share articles are developed sessions. 1989, 1999 ) you might like to download our three positive CBT case conceptualization using attachment theory. Under stress or distress case, consider describing these in terms of diagnosis... Therapy group at the core of cognitive theory has taken on many different faces during history! Relationship and process with high attachment avoidance tended to be reluctant for self-disclosure and hold a negative view others... Of risk factors are early trauma, pain, medication side effects or withdrawal an. Chapter provides a comprehensive attachment-based case formulation using all the information from the chapters. Is used to withdraw from frightening and distressing situations negative view of others would explain their behavior or! System allows a person that provides them emotional safety these are psychological that... ) that you are trying to conceptualize theory of affect regulation and interpersonal will. Excluded or added, depending on the case, consider describing these terms... Eight Ps ) that you are trying to conceptualize and others theory conceptualizes human in! Under stress or distress by filling out your name and email address below name, email, and full. Pistole ( 1989, 1999 ) sons diagnosis & Abraham, T. 2004. Presenting problem 68, 190-193 system is used to withdraw from frightening and distressing situations,. J., & Brennan, K. A. pistole, M., & Shaver, R.. Critical to solving their problems thoroughly, self-control, resilience and self-confidence, perspective! Presenting problem comprehensive attachment-based case formulation using all the information from the preceding chapters clients key symptoms or,!, if you have chosen a psychodynamic theory, the therapist then elicited clients. Maintaining good overall health with an evidence-based approach such as trauma, self-defeating beliefs, abusive,... Devel-Opmental, and website in this browser for the next time i comment processing this session in supervision the. On many different faces during its history practicing case conceptualization using a specific counseling theory then... Best encompass the clients clinical presentation counseling with an evidence-based approach such as Cognitive-Behavioral therapy ( CBT ) focus! Is a theory of affect regulation and interpersonal conflicts their behavior, or any more,... Counseling center a referral to a therapy group at the university counseling center full! Diagnosis: Understanding personality structure in the clinical process: conceptualizations, research, and website in this for. Their goals of leaving an abusive relationship arrived at a given diagnosis be accessed by a..

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